7 - Anxiolytics-Sedatives-Hypnotics
7 - Anxiolytics-Sedatives-Hypnotics
7 - Anxiolytics-Sedatives-Hypnotics
(PhD, BCPS)
[email protected]
Neurophysiology Overview
Overview
Anxiolytic
Drowsiness/Decreased
reaction time
Hypnosis
Confusion, Delirium
and Ataxia
Surgical Anaesthesia
Side Effects
Benzodiazepines
Benzodiazepines
Pharmacological Effects
Anxiolytic: reduction of anxiety and aggression
Sedative and hypnotic: induction of sleep and sedation
Anticonvulsant effect
Muscle relaxant: reduction of muscle tone and
coordination; at high doses, BDZ relax skeletal muscle,
probably by increasing presynaptic inhibition in the spinal
cord, where the 2 GABAA receptors are largely located.
Anterograde amnesia: temporary impairment of memory.
The ability to learn and form new memories is also impaired.
(not the retrograde amnesia)
Drugs used in anxiety disorders
Benzodiazepines
Pharmacological Effects
Classification:
Therapeutic Uses
Reserved for severe anxiety only and not used to manage the stress
of everyday life (addiction potential) .
Drugs used in anxiety disorders
Benzodiazepines
Therapeutic Uses
3. Effective as sedative/hypnotics: useful in treatment of
a. Insomnia
b. Effective muscle relaxants
c. Generate anterograde amnesia
Commonly prescribed benzodiazepines for sleep disorders include
intermediate-acting temazepam and short-acting triazolam.
Long-acting flurazepam is rarely used, due to its extended half-
life, which may result in excessive daytime sedation and
accumulation of the drug, especially in the elderly.
Drugs used in anxiety disorders
Benzodiazepines
Therapeutic Uses
Benzodiazepines
Side Effects (during therapeutic use)
Most Common: mental confusion, disorientation, drowsiness,
lethargy.
Benzodiazepines enhance the depressant effect of other drugs,
including alcohol
Less common: Muscular incoordination, ataxia (a lack of muscle
control during voluntary movements), short term anterograde
amnesia, slurred speech, dementia and seizures may occur if
drug is discontinued abruptly.
Tolerance develops with rebound insomnia; a gradual
escalation of dose needed to produce the required effect.
Drugs used in anxiety disorders
Benzodiazepines
Abuse Potential
There is a low incidence of abuse and
dependence if taken for a short time.
However, prolonged use can lead to
dependence and result in withdrawal.
Withdrawal symptoms include:
Return of anxiety state
increases in rebound insomnia
restlessness
agitation
irritability
Drugs used in anxiety disorders
Benzodiazepines
Benefits
Benzodiazepines
Effects on pregnancy
Benzodiazepines
Effects in Overdose
CNS depression
Unconsciousness
Not being able to take full, deep, normal breaths.
Shallow breathing
Respiratory depression
Collapse of heart and heart functions; decrease blood
pressure and increase heart rate.
Walking difficulty
Flumazenil is used as an effective antagonist of BDZ
Drugs used in anxiety disorders
Benzodiazepines
Effects in Overdose
Flumazenil
Clomethiazole: